Speakers dr woraman widab assist prof olarn prommalikit moderator prof usa thisyakorn
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. Speakers: Dr.Woraman Widab Assist Prof.Olarn Prommalikit Moderator: Prof.Usa Thisyakorn PowerPoint PPT Presentation


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?????????????. Live Vaccine: BCG, OPV, MMR, VZV, OTy, RotaKilled Vaccine: Pertussis, JE, HAV, Rabies Toxoid: Diphtheria, TetanusSubunit (recombinant): HBV, Influenza, aP, HPVPolysaccharide: PS-23, Meningococcal, TyConjugated polysaccharide: Hib, PCV-7 . . ???????????????????????????? ????

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. Speakers: Dr.Woraman Widab Assist Prof.Olarn Prommalikit Moderator: Prof.Usa Thisyakorn

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. Speakers:Dr.Woraman WidabAssist Prof.Olarn Prommalikit Moderator:Prof.Usa Thisyakorn


Live Vaccine:BCG, OPV, MMR, VZV, OTy, Rota

Killed Vaccine:Pertussis, JE, HAV, Rabies

Toxoid:Diphtheria, Tetanus

Subunit (recombinant): HBV, Influenza, aP, HPV

Polysaccharide:PS-23, Meningococcal, Ty

Conjugated polysaccharide:Hib, PCV-7


?


-

-


-

: DTP

8 DTP dT

: DTP 4 4

5

: Hib 2


?


-

-


?


-

-

-

1 MMR VZV

OPV, OTy, Rota



Antibody-Containing Products Vaccines


Ab-Containing Products Live Vaccines


?


-

(chronologic age)

- (HBV)

37

2,000

HBV


-

HBV 1

-

HBV

1 ( 4 )


?


-

subcutaneous fat

- adjuvants (aluminum)

local irritation, inflammation,

granuloma formation, abscess, tissue

necrosis


- sciatic nerve

- hepatitis B rabies

- BCG


Not required aspiration before injection of vaccines


HIV


HIV HIV

-

: BCG

: OPV IPV

: MMR CD4 < 15%

: Influenza,

Hib, PCV-7, HAV, VZV CD4 > 15%


HIV


3

> 2 //

2


OPV, MMR, VZV, OTy, Rota

- OPV, Rota

- EPI

VZV, Influenza


Vaccination VS Steroids


anaphylaxis



DTaP DTwP ?


DTaP DTwP ?

> 3 .

48 .

> 40.5C 48 .

48

.

3


DTwP DTaP ?

Encephalopathy 7 ( DT )

Anaphylaxis


Non-Expanded Program on Immunization


SCOPE

Hib

Pneumococcal Conjugate Vaccine

Varicella Vaccine

Rotavirus Vaccine

Hepatitis A Vaccine

Human papilloma virus Vaccine


.. 2553


.. 2553


Haemophilusinfluenzaetype B vaccine (Hib)


Licensed Hib Vaccine


Licensed Hib Vaccine


-

-


3 4 ?


Recommended Schedule for Doses of Hib vaccine

1 7-10


PNEUMOCOCCAL CONJUGATE VACCINE


?


Global PerspectiveVaccine-Preventable Deaths (WHO)

Estimated number of deaths (WHO 2002)

2,000,000

All ages

1,500,000

Children <5 years

1,000,000

500,000

0

Pneumococcal disease

Measles

Rotavirus

Hib

Pertussis

Tetanus

Other*

Meningococcus

Streptococcus pneumoniae is the leading cause of vaccine-preventable deaths globally

*Polio, diphtheria, yellow fever

WHO. 2004 Global Immunization Data. Available at: http://www.who.int/immunization_monitoring/data/GlobalImmunizationData.pdf. Accessed July 11, 2008.


Leading Infectious Causes of Global Mortality

<5 years

>5 years

3.5

3.5

3.0

2.7

2.2

2.5

1.7

2.0

Deaths (millions)

1.1

1.5

0.9

1.0

0.5

0

AIDS

Diarrhoea

TB

Malaria

Measles

Pneumonia

S. pneumoniae:

~1.6 million deaths, including ~800,000 child deaths

Source: WHO, 2000 Estimates


?


Incidence of community-acquired pneumonia in children under 5 years of age in Thailand

Nakhon Phanomcase per 100,000

Sa Kaeocase per 100,000

Hannah T. Jordan, et at. Int J infect Dis. 2009;13:355-361


Update Invasive Pneumococcal Disease Burden

in Thailand

The incidence of pneumococcal bacteria cases requiring hospitalization among children aged < 5 years had a range of 10.6 28.9 cases per 100,000 persons(May 2005-June 2007, N=116)

28.9

10.6

Note. Antigen detection only. Patients with alarm-positive blood cultures that failed to grow a pathogen on subculture but had media positive by pneumococcal antigen testing (Binax NOW).

BaggettHC, et al. CID. 2009;48:S65-74


Update Invasive Pneumococcal Disease Burden in Thailand

The incidence of IPD in children aged < 5 years per 100,000 persons

The estimates, which are close to estimates of the incidence of hospitalized case of pneumococcal bacteremia in the USA before introduction of PCV

BaggettHC, et al. CID. 2009;48:S65-74


?



?


Comparison of Polysaccharide & Conjugate Vaccines

Pichichero M. Consultant for Pediatricians 2005;June:263-7.


Pneumococcal Conjugate Vaccines

*Trademark

  • Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197 Protein) Prevnar Package Insert. Wyeth Pharmaceuticals Inc.

  • SYNFLORIX Canada Monograph

  • Kieninger D.M. 48th ICAAC/46th IDSA 2008, Abstr # 2638


PCV-7: Serotype Coverage?

50-60 %

60-70 %

70-80 %

80-90 %

100 %


Serotype distribution of invasive pneumococcal disease in Thai children under 5 years old(2000-2005, N=115)

Adapted from Phongsamart W, et al. Vaccine. 2007;25:1275-1280.


Serotype Causing Invasive Infection In Thai Children < 5 Years Old, 2006-2009Collaborative Study; Siriraj, NIH, Chula, Bhumipol, QSNICH

PCV7 = 70.3%

PCV10 = 70.3%

PCV13 = 81.2%

Sterile sites; n=64

Non-Sterile sites; n=42


(effectiveness) ?


Effectiveness of PREVENAR*IPD (U.S.)

55

98%

reduction

Rate per 100,000 persons-year

1.2

Adapted form CDC. MMWR. 2008;57:144-148


Effectiveness of PREVENAR*All Pneumonia & Pneumococcal Pneumonia (U.S.)

After the introduction of PREVENAR, there was a 39% annual decline in all-cause pneumonia admissionsrepresenting ~41,000 fewer pneumonia admissions in 2004 in children <2 years of age

Adapted from Grijalva CG, et al. Lancet. 2007;369:1179-1186.


Effectiveness of PREVNAR*Acute Otitis Media (USA)

Adapted from Zhou F, et al. Pediatrics. 2008;121:253-260.


Effectiveness of PREVENAR*IndirectEffectIPD (U.S.)

  • Kellner JD, et al. CMAJ. 2005;173:1149-1151.

  • Poehling KA, et al. JAMA. 2006;295:1668-1674.


Effectiveness of PREVNAR*antibiotic-resistant IPD

Adapt from Kyaw MH, N Eng J Med. 2006;354:1455-1463


Children at High Risk of Invasive Pneumococcal Infection

  • Immunodeficiency : HIV infection, Congenital immune deficiency(excluding CGD), Diseases associated with immunosuppressive therapy or radiation

  • Thalassemia, asplenia or splenic dysfunction

  • Chronic disease

    : Chronic cardiac disease (cyanotic heart and cardiac

    failure)

    : Chronic pulmonary disease

    : Chronic renal insufficiency (including NS)

    : Diabetes mellitus

  • CSF leaks, cochlear implants

PIDST 2010


Recommened Schedule for Doses of PCV& PS23

PIDST 2010


Varicella Vaccine


PIDST Recommendationsfor Varicella Immunization Schedule

2010

  • 1-12 1-2

    - 12-18

    - 2 4 6 (

    2 4 6

    3 )

  • >13 2 1


?


Breakthrough disease ?


Breakthrough Disease

Breakthrough disease is defined as

a case of infection with wild-type VZV

occurring > 42 days after vaccination

MMWR 2007


Breakthrough Disease

The median number of skin lesions is commonly < 50

Fewer vesicular lesions (lesions more commonly are atypical, with papules that do not progress to vesicles)

Shorter duration of illness

Lower incidence of fever

Watson BM, et al. Pediatrics 1993:91;17-22.


Breakthrough Disease

However, approximately 25-30% of breakthrough cases are not mild, with clinical features more similar to those in unvaccinated children

MMWR 2007


1 Breakthrough disease 2 ?


  • RCT compared efficacy of 1 dose & 2 doses vaccines

  • The cumulative rate of breakthrough varicella during a 10-yr

  • was 3.3-fold lower among children who received 2 doses than

  • that among children who received 1 dose

  • (2.2% and 7.3%; p<0.001)

7.3%

3.3-fold reduction rate

2.2%

Kuter B, et al. Pediatr Infect Dis J 2004;23:132-7.


Risk factors for vaccine failure

Age at vaccination

A retrospective cohort study that adjusted for other potential risk factors demonstrated an increased risk for breakthrough disease for children vaccinated at age < 15 months

(aRR = 1.4; CI = 1.1%-1.9%)

Verstraen T, et al. Pediatrics 2003;112:e98-103.


Risk factors for vaccine failure

An increased risk for breakthrough disease

- oral steroids prescription within 3 months before breakthrough disease

(aRR=2.4; CI=1.3%-4.4%)

- varicella vaccine was administered within 28 days of MMR vaccine

(aRR=3.1; CI=1.5%-6.4%)

No association of risk for breakthrough disease with asthma and eczema

Verstraen T, et al. Pediatrics 2003;112:e98-103.


Risk factors for vaccine failure

Time since vaccination

Active surveillance data during 1995-2004

Children vaccinated > 5 years previously were 2.6 times more likely to have moderate and severe breakthrough varicella than those vaccinated < 5 years previously (p=0.016)

Chaves SS, et al. N Engl J Med 2007;356:1121-9.


Postexposure prophylaxis

Vaccination within 3 days of exposure to rash was 90% effective in preventing varicella whereas vaccination within 5 days of exposure was approximately 70% effective in preventing varicella

100% effective in modifying severe disease

MMWR 2007


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